ICD-10 Coding for Contact Lens Problems The EyeCodingForum.com - - PowerPoint PPT Presentation

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ICD-10 Coding for Contact Lens Problems The EyeCodingForum.com - - PowerPoint PPT Presentation

Feb 18, 2024 40 likes •365 views

ICD-10 Coding for Contact Lens Problems The EyeCodingForum.com Jeffrey Restuccio, CPC, CPC-H, M BA M emphis TN (901) 517-1705 jeff@eyecodingforum.com www.EyeCodingForum.com EyeCodingForum.com 1 Coding for Contact Lens Complications M

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ICD-10 Coding for Contact Lens Problems The EyeCodingForum.com

Jeffrey Restuccio, CPC, CPC-H, M BA M emphis TN (901) 517-1705 jeff@eyecodingforum.com www.EyeCodingForum.com

EyeCodingForum.com 1

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Coding for Contact Lens Complications

  • M any common conditions/ diseases are not listed in the

current ICD-9 manual. How will they translate to ICD-10? Will it correct all the omissions and incorrect descriptions currently found in ICD-9?

  • For the most part, no.
  • Y

es, Dry Eye Syndrome will now be part of the ICD-10 code description.

  • But many will continue to retain international descriptions

that are different from common terms used in the United States.

EyeCodingForum.com 2

H04.121 Dry eye syndrome of right lacrimal gland

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T

  • p Five Contact Code Problem ICD-9

Codes/ Conditions

  • ICD-9 and Description

EyeCodingForum.com 3

ICD-9 Description 368.8 Blurred Vision 379.91 Eye Pain 379.93 Redness of Eyes 375.15 Dry Eyes 368.2 Double Vision/ diplopia This list includes about 80% of visits for contact lens-related problems.

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ICD-10 Crosswalk

  • Note separate diplopia and double vision codes.

EyeCodingForum.com 4

1) H57.8 Other specified disorders of eye and adnexa [blurred vision crosswalk] 2) H57.13 Ocular pain, bilateral [four codes] 3) H57.8 Other specified disorders of eye and adnexa [redness] 4) H04.121 Dry eye syndrome of right lacrimal gland [four codes] 5) H53.2 Diplopia [ICD-9 crosswalk to 368.2] H53.19 Other subjective visual disturbances [Includes: Double vision; ICD-9 crosswalk: 368.15] 368.15: Subjective visual disturbances: other visual distortions and entoptic (visual effects whose source is within the eye itself) phenomena

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Common Coding Errors

  • The two codes are recommended above but 375.15 is clearly

incorrect per ICD-9 guidelines.

EyeCodingForum.com 5

371.82 Corneal Disorder due to Contact Lens 375.15 Corneal Edema due to Wearing of Contact Lens [this is an error per ICD-9] 371.82 Other corneal disorders: corneal disorder due to contact lens Excludes corneal edema due to contact lens (371.24) 371.15 Corneal pigmentations and deposits: other deposits associated with metabolic disorders [actual ICD-9 description]

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Correct Contact ICD-10 Codes

  • Correct ICD-9 code

EyeCodingForum.com 6

371.24 Corneal edema: corneal edema due to wearing of contact lenses H18.219 Corneal edema secondary to contact lens, unspecified eye 371.82 Corneal Disorder due to Contact Lens H18.829 Corneal disorder due to contact lens, unspecified eye

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Other conditions

  • How does one code for: more serious

conditions like corneal hypoxia, infiltrates, and microbial keratitis?

EyeCodingForum.com 7

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Terms and definitions

  • SEAL: Superior Epithelial Arcuate Lesion: It is a white lesion in the

superior cornea that can be up to 0.5 mm wide and from 1 mm to 5 mm long.

  • CLARE: Contact Lens-induced Acute Red Eye: A sudden onset of a

corneal infiltrative event observed during extended wear of hydrogel contact lenses that is always associated with sleep. Patients report waking up with irritation or pain, redness and watery eyes. Sometimes, these symptoms are not noticed until soon after waking (HPI: timing).

  • CLPU: Contact Lens-induced Peripheral Ulcer: A circular, well-

circumscribed, dense, yellowish-white, focal corneal infiltrate (0.2 mm to 2.0 mm in diameter) located in the peripheral to mid- peripheral cornea. It is always located in the anterior stroma and has a complete loss of overlying epithelium. S ymptoms can vary but may include pain or soreness, irritation and watering.

EyeCodingForum.com 8

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Terms and definitions

  • M icrocysts: Small (15 μm to 50 μm), irregularly shaped

inclusions, typically found in the paracentral to mid-peripheral zones of the cornea, best observed with retro-illumination. These show reversed illumination due to a suspected higher refractive index than the surrounding tissue.

  • Often clear and asymptomatic. Report the underlying

symptoms:

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Terms and definitions

  • M K — M icrobial Keratitis: occurs as a result of an infection of

the cornea by replicating microbes (bacterial, viral, fungal or amoebae). In contact lens wear, it is usually preceded by hypoxia and/ or an epithelial break. Contact lens wearers, in particularly extended wear, are more prone to develop M K. The most common bacteria associated with contact lens- related M K is Pseudomonas aeruginosa.

  • Bacteria tend to bind to the back surface of silicone hydrogel

lenses after patients have been swimming. Always recommend that patients remove and disinfect their lenses after any exposure to pools, lakes or rivers.

EyeCodingForum.com 10

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Top M K Symptoms ICD-9 Codes

  • Top codes

EyeCodingForum.com 11

1 370.03 Corneal Ulcer, Central 2 364.03 Secondary Iridocyclitis, Infectious 3 379.91 Unspecified disorder of eye and adnexa: pain in or around eye [eye pain] 4 379.93 Other specified disorders of eye and adnexa [ redness of Eyes] 4 375.21 Epiphora 5 368.13 Photophobia

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Top M K Symptoms ICD-9 Codes

  • ICD-10 crosswalk. Not always exact.

EyeCodingForum.com 12

1 H16.011 Corneal Ulcer, Central 2 Secondary Iridocyclitis, Infectious H20.031 Secondary infectious iridocyclitis, right eye [also noninfectious, H20.041] 3 H57.13 Ocular pain, bilateral 4 H57.8 Redness of Eyes [no eye code] 5 H04.201 Unspecified epiphora, right lacrimal gland H04.211 Epiphora due to excess lacrimation, right lacrimal gland H04.221 Epiphora due to insufficient drainage, right lacrimal gland

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Top M K Symptoms ICD-9 Codes

  • ICD-10 crosswalk. Not always exact.
  • Only report those codes documented, relevant to this

encounter, and sufficient to support medical necessity for a given procedure or office visit.

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6 H53.149 Photophobia H53.149 Visual discomfort, right eye [Includes: M etamorphopsia; photophobia term not in ICD-10]

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Other Complications

  • Exposure keratitisis not found in the ICD-9 manual.

It is listed as: exposure keratoconjunctivitis

  • It is an incomplete closure of the eyelid causing a dry,

inflamed eye.

EyeCodingForum.com 14

370.34 Certain types of keratoconjunctivitis: exposure keratoconjunctivitis H16.219 Exposure keratoconjunctivitis, unspecified eye

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Exposure keratoconjunctivitis

  • All codes; Note codes are not by eyelid.

EyeCodingForum.com 15

H16.211 Exposure keratoconjunctivitis, right eye H16.212 Exposure keratoconjunctivitis, left eye H16.213 Exposure keratoconjunctivitis, bilateral H16.219 Exposure keratoconjunctivitis, unspecified eye

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Keratoconjunctivis sicca

  • Keratoconjunctivitis sicca has two options in ICD-9.
  • The condition involves reporting biomicroscopic findings

without referring to the underlying cause.

EyeCodingForum.com 16

710.2 Diffuse diseases of connective tissue: sicca syndrome Keratoconjunctivitis sicca Sjogren's disease [Sjögren's syndrome] 370.33 Certain types of keratoconjunctivitis: keratoconjunctivitis sicca, not specified as Sjogren's [dry eyes]

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Remember, International Definitions

  • Keratoconjunctivitis sicca (KCS), (aka keratitis sicca,

xerophthalmia or dry eye syndrome, is an eye disease caused by eye dryness it is caused by either decreased tear production or increased tear-film evaporation.

EyeCodingForum.com 17

H16.221 Keratoconjunctivitis sicca, not specified as Sjögren's, right eye H16.222 Keratoconjunctivitis sicca, not specified as Sjögren's, left eye H16.223 Keratoconjunctivitis sicca, not specified as Sjögren's, bilateral H16.229 Keratoconjunctivitis sicca, not specified as Sjögren's, unspecified eye

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Dry Eye Syndrome

  • Use the following ICD-10 code for DES

EyeCodingForum.com 18

H04.121 Dry eye syndrome of right lacrimal gland H04.122 Dry eye syndrome of left lacrimal gland H04.123 Dry eye syndrome of bilateral lacrimal glands H04.129 Dry eye syndrome of unspecified lacrimal gland

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Sicca Syndrome ICD-10

  • GEM S Crosswalk of ICD-9: 710.2
  • Listed also as Sjögren's syndrome: a systemic autoimmune

disease in which immune cells attack and destroy the exocrine glands, which produce tears and saliva. Unless it was diagnosed separately, M 35.01 would be the correct code.

EyeCodingForum.com 19

ICD-10 Description M 35.00 Sicca syndrome, unspecified M 35.01 Sicca syndrome with keratoconjunctivitis

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M ore Terms

  • CLPC : Contact Lens-induced Papillary Conjunctivitis (Aka Giant

Papillary Conjunctivitis [GPC]): S ymptoms may range from mild hyperemia of the upper tarsal conjunctiva with a few, small papillae to severe hyperemia with large, raised papillae, which have a cobblestone appearance. CLPC may present as a localized or generalized response. S ymptoms include itching and a stringy or ropy mucous discharge. Excessive lens movement or decentration and blurred vision may also occur. Lens material, design or fitting characteristics may need to be modified to prevent recurrence of this condition. Etiologies for CLPC include: mechanical abrasion from poor edge design and protein film abrasiveness.

  • A code does exist, but it's not called GPC. It all depends on the
  • etiology. Since papillae aren't follicles, we can't use the code for

follicular conjunctivitis.

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Incorrect Coding

  • Some Eyecare coding consultants recommend code 372.10,

chronic conjunctivitis, unspecified, for an allergic underlying

  • cause. Again, there are additional codes:

EyeCodingForum.com 21

372.14 Chronic conjunctivitis: other chronic allergic conjunctivitis H10.401 Unspecified chronic conjunctivitis, right eye H10.411 Chronic giant papillary conjunctivitis, right eye H10.421 Simple chronic conjunctivitis, right eye H10.431 Chronic follicular conjunctivitis, right eye

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M ore Dx

  • Ulcers of the eye; note by eye.

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H16.001 Unspecified corneal ulcer, right eye H16.011 Central corneal ulcer, right eye H16.021 Ring corneal ulcer, right eye H16.031 Corneal ulcer with hypopyon, right eye H16.041 M arginal corneal ulcer, right eye H16.051 M ooren's corneal ulcer, right eye H16.061 M ycotic corneal ulcer, right eye H16.071 Perforated corneal ulcer, right eye

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Other Complications

  • M ore codes

EyeCodingForum.com 23

ICD-9 ICD-10 Description 370.6 H16.401 Corneal Neovascularization 370.64 H16.419 Corneal Ghost Vessels

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24

Sample CM S-1500 Form

Use for unlisted codes, co-management and unique situations 92225 -RT 377.00 Papilledema 11 1 03/ 1/ 2010 92014 03/ 1/ 2010 11 V58.69 High Risk M ed - Plaquenil 714.0 Rheumatoid arthritis 2,3 03/ 1/ 2010 11 077.3 Other adenoviral conjunctivitis 87809 4

Use for unlisted codes, co-management and unique situations

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Crosslinks

  • ICD-10 codes
  • Is this correct?

EyeCodingForum.com 25

ICD-9 ICD-10 Description 377.00 H47.10 Papilledema [unspecified] V58.69 Z79.899 High Risk M ed - Plaquenil 714.0 M 06.9 Rheumatoid arthritis 077.3 B30.1 Other adenoviral conjunctivitis

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Not exactly

  • There’s always more. These are the ICD-10 descriptions.
  • The ICD-10 codes must be reviewed individually—now before the

implementation date; otherwise you will be substituting old unspecific codes for new unspecific codes—that may be inaccurate and cause a denial.

EyeCodingForum.com 26

377.00 H47.10 Unspecified papilledema V58.69 Z79.899 Other long term (current) drug therapy 714.0 M 06.9 Rheumatoid arthritis, unspecified 077.3 B30.1 Conjunctivitis due to adenovirus

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Papilledema codes

  • M ore papilledema codes.

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H47.10 Unspecified papilledema H47.11 Papilledema associated with increased intracranial pressure H47.12 Papilledema associated with decreased ocular pressure H47.13 Papilledema associated with retinal disorder

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Rheumatoid arthritis

  • Rheumatoid arthritis

EyeCodingForum.com 28

M 06.00 Rheumatoid arthritis without rheumatoid factor, unspecified site [M ore 6th digit site codes] M 06.80 Other specified rheumatoid arthritis, unspecified site

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Adenovirus

B30.0 Keratoconjunctivitis due to adenovirus B30.1 Conjunctivitis due to adenovirus [crosswalk] B30.2 Viral pharyngoconjunctivitis B30.3 Acute epidemic hemorrhagic conjunctivitis (enteroviral) B30.8 Other viral conjunctivitis B30.9 Viral conjunctivitis, unspecified

EyeCodingForum.com 29

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The Bottom Line

  • While many codes have a clean crosswalk most problems are

crosswalking an unspecific ICD-9 code to an unspecific ICD-10 code.

  • The ICD-10 codes must be reviewed early to determine which

are relevant and which are not.

  • M ost won’t even know the correct questions to ask. I will help

you ask the right questions.

  • That is the goal of the complete ICD-10 training course and

additional webinars we will be conducting throughout 2014.

  • M any carriers will not have representatives knowledgeable

about Eyecare. It will be a challenge determining which codes they require after the October 1 2014 implementation date.

EyeCodingForum.com 30

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Questions?

  • If you order the complete ICD-10 training course

($225) or the $299 bundle after purchasing this 50-minute Webinar for $49, contact ECF@eyecodingforum.com for a rebate code.

  • The EyeCodingForum is your one-stop source for

all ICD-10 coding updates.

  • In addition, we will continue to have monthly

webinars on coding, billing, documentation and compliance topics relevant to Eyecare (both Optometrists and Ophthalmologists).

EyeCodingForum.com 31

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Thank you for listening to the EyeCodingForum’s ICD-10 Coding for Contact Lens Problems

Jeffrey Restuccio, CPC, CPC-H, M BA M emphis TN (901) 517-1705 jeff@eyecodingforum.com www.EyeCodingForum.com

EyeCodingForum.com 32